Vancouver prescription heroin program hits a snag that interrupts treatment for some patients

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      Perhaps to no one’s surprise, it turns out that supplying heroin to people without breaking the law is not an easy or a simple thing to do.

      Since November 2014, a program run out of a clinic in Vancouver’s Downtown Eastside has done just that—that is, giving chronic addicts free prescription heroin, otherwise known as diacetylmorphine. But there was recently a hitch in the supply chain, which effectively put the harm-reduction initiative called heroin maintenance on hold.

      David Lefebvre, a spokesperson for its operator, Providence Health Care, told the Straight that “due to a permit issue”, doctors at Crosstown Clinic had to transition patients to another drug called hydromorphone, a synthetic derivative of morphine. He noted that for some addicts, the change has been a struggle.

      “This is the first time in North America that any clinic has provided diacetylmorphine to people who have chronic heroin addictions and that is a process that is extremely complex,” he said in a telephone interview.

      Lefebvre explained that Crosstown was forced to begin transitioning patients roughly two weeks ago and hopes to have a majority of those people back on diacetylmorphine when a shipment of the drug arrives from a supplier in Europe “sometime in mid-September”.

      “The reality is, the movement of diacetylmorphine is governed internationally, so it is so much more complex than people realize,” he explained. “It is not just a national issue with Health Canada, it is not just a national issue with the Office of Controlled Substances. It is also an international issue.”

      Lefebvre said where exactly in the supply chain this problem occurred is in transit at a point across the Atlantic Ocean.

      “The permit system in Europe takes six to eight weeks for drugs to be exported to Canada,” he said. “That results in delays that affect our ability to provide diacetylmorphine to our patients. Due to this time lag, Crosstown has had to transition some patients onto hydromorphone.”

      Lefebvre cautioned that even after Providence receives its next shipment of diacetylmorphine in mid-September, the same problem could occur again.

      “We are expecting continued issues with regard to supply due to this importation time lag,” he conceded.

      Lefebvre acknowledged that for many long-term addicts, the transition off of heroin, even to another opiate such as hydromorphone, is not a painless experience. “We appreciate that this is challenging for them,” he said.

      In past interviews, Lefebvre stressed that heroin-assisted treatment is only recommended as an appropriate intervention for individuals who have repeatedly failed with traditional therapies such as methadone.

      In accordance with a B.C. Supreme Court injunction granted in May 2014, to be eligible to receive prescription heroin, a patient must have participated in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), an academic program that began at Crosstown Clinic in 2011. The average SALOME participant has failed with traditional treatment for opioid dependence an average of 11 times.

      The number of eligible past SALOME participants is 202. Of that group, Lefebvre said doctors have written diacetylmorphine prescriptions for 120 patients. He declined to specify how many of that group were affected by disruptions in the supply chain.

      Health Canada has steadfastly opposed Vancouver’s prescription heroin program. The province’s Health Minister, Terry Lake, has stood behind regional authorities and supported it.




      Aug 5, 2015 at 6:59pm

      Exactly why doesn't Canada have its own supply of heroin? Heroin is not difficult to synthesize, poppies are not difficult to cultivate.


      Aug 6, 2015 at 7:32am

      Did nobody notice that Terry Lake of the provincial Liberals supports this program? They support supplying free heroin to people with a severe addiction to it. I had no idea.


      Aug 6, 2015 at 10:43am

      Yep, if you want to shoot up heroin, the province and city are behind you---even coastal health is. but marijuana edibles? No, sir! I don't think these experts are half as kind as people think---it's a cost-benefit analysis; shooting gallerys provide a reduction in overall budget expenses, where pot edibles don't. it's not compassion; it's accounting.

      jim anon

      Aug 6, 2015 at 6:17pm

      They have thrown them to wolves,i.e. the libs. have.The difficulty in accessing even basic subsistence ,no real rehab and all the money going to middle class healthcare and vpd is what has occurred.

      Barry William Teske

      Aug 9, 2015 at 6:37am

      "Lefebvre said where exactly in the supply chain this problem occurred is in transit at a point across the Atlantic Ocean."

      Not to take away from the very important dialogue on this issue but...
      The War on Drugs some of our vaulted world leaders go on about ad nauseum just got outed.
      Excuse me.
      Its morning and I'm stretching but.
      Does anyone else see the chink in the armor after reading the part I quoted?
      They don't always line up do they?